| 3-D radiotherapy plan dose-volume histograms (77295) |
— |
$13,358 |
— |
| Abdomen 2 views (74019) |
— |
$935 |
— |
| Acute gastrointestinal blood loss imaging (78278) |
— |
$2,938 |
— |
| Angiography extremity bilateral rs&i (75716) |
— |
$7,575 |
— |
| Angiography extremity unilateral rs&i (75710) |
— |
$5,732 |
— |
| Angiography internal mammary rs&i (75756) |
— |
$4,604 |
— |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
— |
$6,167 |
— |
| Angiography pulmonary bilateral slctv rs&i (75743) |
— |
$7,549 |
— |
| Angiography pulmonary unilateral slctv rs&i (75741) |
— |
$6,335 |
— |
| Angiography Spinal Selective Rs&I (75705) |
— |
$7,066 |
— |
| Angiography visceral slctv/supraslctv rs&i (75726) |
— |
$7,224 |
— |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
— |
$2,726 |
— |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
— |
$3,617 |
— |
| Ankle 2 views (73600) |
— |
$604 |
— |
| Antegrade urography radiological supvj & interpj (74425) |
— |
$1,314 |
— |
| Aortogram thoracic (75605) |
— |
$8,731 |
— |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
— |
$7,355 |
— |
| Aortography abdominal serialography rs&i (75625) |
— |
$5,579 |
— |
| Aortography thoracic w/o serialography rs&i (75600) |
— |
$9,081 |
— |
| Artery X-Rays Adrenal Gland (75731) |
— |
$13,635 |
— |
| Arthrogram hip (73525) |
— |
$1,122 |
— |
| Arthrogram shoulder (73040) |
— |
$932 |
— |
| Arthrogram wrist (73115) |
— |
$697 |
— |
| Arthrography knee lt (73580) |
— |
$1,146 |
— |
| Basic radiation dosimetry calculation (77300) |
— |
$1,305 |
— |
| Bone &/Joint Imaging Limited Area (78300) |
— |
$2,080 |
— |
| Bone &/Joint Imaging Multiple Areas (78305) |
— |
$2,481 |
— |
| Bone &/joint imaging whole body (78306) |
— |
$4,627 |
— |
| Bone age studies (77072) |
— |
$478 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$4,708 |
— |
| Bone Marrow Imaging Limited Area (78102) |
— |
$1,892 |
— |
| Bone survey complete (77075) |
— |
$1,792 |
— |
| Brachytx isodose complex (77318) |
— |
$3,384 |
— |
| Brachytx isodose intermed (77317) |
— |
$2,492 |
— |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
— |
$2,131 |
— |
| Brain image w/flow 4 + views (78606) |
— |
$2,917 |
— |
| Brain imaging < 4 static views (78600) |
— |
$1,817 |
— |
| Brain imaging < 4 static views w vascular flow (78601) |
— |
$2,369 |
— |
| Brain Imaging Vascular Flow Only (78610) |
— |
$1,713 |
— |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
— |
$4,246 |
— |
| Cardiac MRI w/w/o contrast & further seq (75561) |
— |
$4,127.50 |
— |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
— |
$2,056 |
— |
| Cervical spine 2 or 3 views (72040) |
— |
$793 |
— |
| Chest 1 view (71045) |
— |
$526 |
— |
| Chest 3 views (71047) |
— |
$686 |
— |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
— |
$1,162 |
— |
| Cineradiography/videoradiography (76120) |
— |
$1,020 |
— |
| Clavicle complete (73000) |
— |
$704 |
— |
| Complete single session course of cranial lesion surgery using radiation (77371) |
— |
$59,476 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$362 |
— |
| Continuing medical physics consltj pr wk (77336) |
— |
$1,324 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$6,577 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$4,651 |
— |
| CT abdomen w contrast (74160) |
— |
$8,106 |
— |
| CT abdomen w wo contrast (74170) |
— |
$7,255 |
— |
| CT abdomen w/o contrast (74150) |
— |
$5,199 |
— |
| CT angio hrt w/3d image (75574) |
— |
$6,931 |
— |
| CT angiography upper extremity lt (73206) |
— |
$6,968 |
— |
| CT c-spine w/o contrast (72125) |
— |
$3,318 |
— |
| CT cervical spine w&w/o contrast (72127) |
— |
$6,131 |
— |
| CT cervical spine with contrast (72126) |
— |
$7,344 |
— |
| CT chest w/wo contrast (71270) |
— |
$6,647 |
— |
| CT chest with contrast (71260) |
— |
$3,245 |
— |
| CT colonography screening (74263) |
— |
$2,236 |
— |
| CT colonography w/dye (74262) |
— |
$2,986 |
— |
| CT colonography w/o cntrst (74261) |
— |
$2,936 |
— |
| CT head/brain with contrast (70460) |
— |
$5,817 |
— |
| CT head/brain without and with contrast (70470) |
— |
$7,136 |
— |
| CT heart contrast eval cardiac structure&morph (75572) |
— |
$5,306.50 |
— |
| CT heart no contrast quant eval coronry calcium (75571) |
— |
$304.50 |
— |
| CT hrt w/3d image congen (75573) |
— |
$5,558 |
— |
| CT iac w contrast (70481) |
— |
$5,555 |
— |
| CT limited/localized follow up study (76380) |
— |
$2,850 |
— |
| CT lower ext w/o (73700) |
— |
$4,557 |
— |
| CT lower extremity w wo contrast (73702) |
— |
$5,887 |
— |
| CT lower extremity with contrast (73701) |
— |
$5,979 |
— |
| CT lumbar spine w & w/o contrast (72133) |
— |
$5,992 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$1,839 |
— |
| CT lumbar spine with contrast (72132) |
— |
$4,248 |
— |
| CT maxillofacial w contrast (70487) |
— |
$4,837 |
— |
| CT maxillofacial w/o contrast (70486) |
— |
$4,337 |
— |
| CT maxillofacial w/wo contrast (70488) |
— |
$5,963.50 |
— |
| CT neck soft tissue w contrast (70491) |
— |
$2,808 |
— |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
— |
$4,945.50 |
— |
| CT orbits w/o contrast (70480) |
— |
$4,781.50 |
— |
| CT pelvis w & w/o contrast (72194) |
— |
$8,866 |
— |
| CT pelvis w/o contrast (72192) |
— |
$3,623.50 |
— |
| CT scan for measuring calcium and other minerals in bone (77078) |
— |
$671 |
— |
| CT soft tissue neck w/o & w/contrast material (70492) |
— |
$5,318.50 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$4,131 |
— |
| CT thoracic spine w/contrast (72129) |
— |
$6,643 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$3,951 |
— |
| CT thoracic spine w/wo contrast (72130) |
— |
$6,439 |
— |
| CT thorax w/o contrast (71250) |
— |
$2,596 |
— |
| CT unlisted procedure (76497) |
— |
$2,169.50 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$5,465 |
— |
| CT upper extremity w/o contrast rt (73200) |
— |
$4,833 |
— |
| CT upper extremity with contrast (73201) |
— |
$6,421 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$10,132 |
— |
| Cta Abdomen (74175) |
— |
$5,621.50 |
— |
| CTA abdomen pelvis (74174) |
— |
$3,137 |
— |
| CTA chest (71275) |
— |
$2,271 |
— |
| Cta Head (70496) |
— |
$4,123 |
— |
| CTA lwr ext w&w/o contrast (73706) |
— |
$6,183 |
— |
| Cta Neck (70498) |
— |
$4,179.50 |
— |
| Cta Pelvis (72191) |
— |
$4,762.50 |
— |
| Cystography minimum 3 views rs&i (74430) |
— |
$1,270.50 |
— |
| Dacryocystography (70170) |
— |
$581 |
— |
| Diskogram cervical (72285) |
— |
$3,439 |
— |
| Diskography lumbar (72295) |
— |
$3,647 |
— |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
— |
$973 |
— |
| Doppler Echo Fetal Spectral Display Complete (76827) |
— |
$1,348 |
— |
| Dxa bone density study 1/> sites axial skel (77080) |
— |
$827 |
— |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
— |
$510 |
— |
| Dxa bone density study axial skeleton (77085) |
— |
$1,047 |
— |
| Echo exam of fetal heart (76825) |
— |
$2,711 |
— |
| Echo fetal cardiovasc w/wo m-mode repeat std (76826) |
— |
$1,570 |
— |
| Echoencephalography real time imaging (76506) |
— |
$1,162 |
— |
| Esophageal motility (78258) |
— |
$1,731 |
— |
| Esophagus (74220) |
— |
$1,151 |
— |
| Fetal biophysical profile non-stress testing (76818) |
— |
$1,475 |
— |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
— |
$1,304 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$1,042.50 |
— |
| Foot 2 views (73620) |
— |
$701 |
— |
| Forearm 2 views (73090) |
— |
$743 |
— |
| Functional MRI brain by tech (70554) |
— |
$5,325 |
— |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) |
— |
$6,180 |
— |
| Gated Heart Planar Single (78472) |
— |
$2,924 |
— |
| Hand 2 views (73120) |
— |
$684 |
— |
| Hand 3 views (73130) |
— |
$739 |
— |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
— |
$5,854 |
— |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
— |
$6,883 |
— |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
— |
$7,728 |
— |
| Hdr rdncl sk srf brchytx les >2cm&2chan/mlt les (77768) |
— |
$2,810 |
— |
| Hdr rdncl skn surf brachytx les </2cm/1 chan (77767) |
— |
$4,380 |
— |
| Heart Infarct Image (78466) |
— |
$2,574 |
— |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
— |
$3,787 |
— |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
— |
$4,280 |
— |
| Hepatobiliary syst imaging including gallbladder (78226) |
— |
$4,280 |
— |
| Ht muscle image spect sing (78451) |
— |
$5,302 |
— |
| Humerus Min 2 Views Left (73060) |
— |
$654 |
— |
| Hysterosalpingogram (74740) |
— |
$1,326 |
— |
| Interstitial radiation source applic complex (77778) |
— |
$7,845 |
— |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
— |
$428 |
— |
| Kidney funcj study non-img radioisotopic study (78725) |
— |
$2,947 |
— |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
— |
$4,096 |
— |
| Kidney img morphology vascular flow 1 w/rx (78708) |
— |
$4,332 |
— |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
— |
$4,028 |
— |
| Knee 3 views (73562) |
— |
$757 |
— |
| Liver & spleen imaging static only (78215) |
— |
$2,670 |
— |
| Liver imaging static only (78201) |
— |
$2,485 |
— |
| Liver imaging w/vascular flow (78202) |
— |
$2,997 |
— |
| Lung perf&ventilat diferentl (78598) |
— |
$4,573 |
— |
| Lung perfusion differential (78597) |
— |
$3,503 |
— |
| Lung Ventilation Imaging (78579) |
— |
$2,503 |
— |
| Lymphangio Abd/Pelv Bilat - Ir Lymphangiogram Abdomen Pelvis Bilat (75807) |
— |
$3,351 |
— |
| Lymphangio extrem unilat - ir lymphangiogram extremity (75801) |
— |
$1,686 |
— |
| Lymphangiography extremity only bilateral rs&i (75803) |
— |
$3,480 |
— |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
— |
$4,153 |
— |
| Lymphoscintigraphy (78195) |
— |
$3,102 |
— |
| Mammary ductogram or galactogram multiple (77054) |
— |
$1,125 |
— |
| Mammary ductogram or galactogram single (77053) |
— |
$941.50 |
— |
| Meckels Diverticulum (78290) |
— |
$923 |
— |
| Mlc imrt design & construction per imrt plan (77338) |
— |
$1,788.50 |
— |
| Mr elastography (76391) |
— |
$7,850 |
— |
| MRA head w & w/o contrast (70546) |
— |
$4,402 |
— |
| MRA head w/o contrast (70544) |
— |
$2,380 |
— |
| MRA head with contrast (70545) |
— |
$5,184 |
— |
| MRA neck w contrast (70548) |
— |
$5,172 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$3,028 |
— |
| MRA neck w/o contrast (70547) |
— |
$4,858 |
— |
| MRI abdomen w contrast (74182) |
— |
$6,350 |
— |
| MRI abdomen w/o & w/contrast material (74183) |
— |
$4,543 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$5,579 |
— |
| MRI any jnt lwr ext with con lt (73722) |
— |
$8,654 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$7,093 |
— |
| MRI breast w/o contrast bilateral (77047) |
— |
$7,518 |
— |
| MRI breast w/o contrast unilat (77046) |
— |
$5,011 |
— |
| MRI c-spine with contrast (72142) |
— |
$8,148 |
— |
| MRI cardiac w/o cont stress (75559) |
— |
$6,110 |
— |
| MRI cardiac w/o contrast (75557) |
— |
$3,740 |
— |
| MRI cervical spine w/o contrast (72141) |
— |
$3,894 |
— |
| MRI chest w/o & w/contrast material (71552) |
— |
$10,255 |
— |
| MRI chest w/o contrast (71550) |
— |
$6,854 |
— |
| MRI chest with contrast (71551) |
— |
$5,509 |
— |
| MRI fetal sngl/1st gestation (74712) |
— |
$6,012 |
— |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
— |
$6,887 |
— |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
— |
$5,453 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$6,863 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$8,507 |
— |
| MRI orbit/face/neck w&w/o cont (70543) |
— |
$8,507 |
— |
| MRI orbit/face/neck w/contrast (70542) |
— |
$3,789 |
— |
| MRI pelvis w contrast (72196) |
— |
$5,681 |
— |
| MRI pelvis w/o & w/contrast material (72197) |
— |
$10,567 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$3,461 |
— |
| MRI scan of arm joint before and after contrast (73223) |
— |
$8,120 |
— |
| MRI scan of heart before and after contrast with stress imaging (75563) |
— |
$6,158 |
— |
| MRI scan of leg joint before and after contrast (73723) |
— |
$8,996 |
— |
| MRI spectroscopy (76390) |
— |
$4,423.50 |
— |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
— |
$10,567 |
— |
| MRI spinal canal lumbar w/contrast material (72149) |
— |
$8,627 |
— |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
— |
$5,624 |
— |
| MRI spinal canal thoracic w/contrast matrl (72147) |
— |
$9,035 |
— |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
— |
$10,176 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$3,786 |
— |
| MRI tmj (70336) |
— |
$4,026 |
— |
| MRI upper ext joint w/o contrast (73221) |
— |
$6,411.50 |
— |
| MRI upper extrem other than jt w/o & w/contras (73220) |
— |
$7,986 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$6,159 |
— |
| Myelogram Cervical (72240) |
— |
$2,336 |
— |
| Myelogram Lumbar (72265) |
— |
$2,099 |
— |
| Myelogram thoracic (72255) |
— |
$1,920 |
— |
| Myelography 2 or more regions (72270) |
— |
$2,299 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$2,488 |
— |
| Myocrd img PET metab eval single study cncrnt CT (78429) |
— |
$9,807 |
— |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
— |
$6,051 |
— |
| Myocrd img PET prfuj mlt std rst&strs cncrnt CT (78431) |
— |
$6,051 |
— |
| Myocrd img PET prfuj w/metab 2rtracer cncrnt CT (78433) |
— |
$6,051 |
— |
| Myocrd img PET prfuj w/metab dual radiotracer (78432) |
— |
$6,051 |
— |
| N-Invas Est C Ffr Augmnt Sw Alys Cta I&R Phy/Qhp (75580) |
— |
$4,018.50 |
— |
| Neck soft tissue (70360) |
— |
$649 |
— |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
— |
$718 |
— |
| Nm bone marrow multiple (78103) |
— |
$1,689 |
— |
| Nm cisternogram (78630) |
— |
$3,257 |
— |
| Nm csf leak detection (78650) |
— |
$2,383 |
— |
| Nm gastric emptying study (78264) |
— |
$3,736 |
— |
| Nm peritoneal-venous shunt patency (78291) |
— |
$2,212 |
— |
| Ntsty modul radthx pln dose-vol histos (77301) |
— |
$11,395 |
— |
| Nuclear medicine of heart muscle at rest with stress (78454) |
— |
$4,999.50 |
— |
| Nuclear medicine of heart pumping function (78473) |
— |
$3,950 |
— |
| Nuclear medicine study of heart muscle at rest with stress (78453) |
— |
$4,212 |
— |
| Nuclear medicine study of stomach to assess emptying small bowel movement (78265) |
— |
$3,204 |
— |
| Nuclear Rx Oral Admin (79005) |
— |
$3,117 |
— |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
— |
$244 |
— |
| Ophthalmic us dx quantitative a-scan only (76511) |
— |
$731 |
— |
| Orthopantogram (70355) |
— |
$509 |
— |
| Osseous survey infant (77076) |
— |
$1,232 |
— |
| Osseous survey limited (77074) |
— |
$713 |
— |
| Parathyrd planar w/spect&CT (78072) |
— |
$4,409 |
— |
| Parathyrd planar w/wo subtrj (78071) |
— |
$3,236 |
— |
| Parathyroid imaging (78070) |
— |
$3,237 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$695 |
— |
| Perineogram (74775) |
— |
$1,711 |
— |
| Peritoneogram rs&i (74190) |
— |
$1,279 |
— |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
— |
$8,376 |
— |
| Proton tx delivery complex (77525) |
— |
$11,447 |
— |
| Proton tx delivery intermediate (77523) |
— |
$6,603 |
— |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
— |
$2,955 |
— |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
— |
$4,472 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$2,605 |
— |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
— |
$4,573 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$1,047 |
— |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
— |
$668 |
— |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
— |
$721 |
— |
| Radex hips bilateral with pelvis 2 views (73521) |
— |
$862 |
— |
| Radex mastoids compl minimum 3 views pr side (70130) |
— |
$641 |
— |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
— |
$668 |
— |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
— |
$65,401 |
— |
| Radiation treatment delivery 1 mev >= complex (77412) |
— |
$2,047 |
— |
| Radiation treatment delivery 1 mev >= simple (77402) |
— |
$1,332 |
— |
| Radiation tx delivery 1 mev >= intermediate (77407) |
— |
$1,005 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$878 |
— |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
— |
$764 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$1,107 |
— |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
— |
$374 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$1,726 |
— |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
— |
$1,273 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$1,936 |
— |
| Radiologic exam upr gi trc single contrast study (74240) |
— |
$1,511 |
— |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
— |
$530 |
— |
| Radiological examination surgical specimen (76098) |
— |
$1,002 |
— |
| Radiopharmaceutical therapy, by intra-articular administration Age Under 21 (79440) |
— |
$1,373 |
— |
| Review by radiologist of adrenal gland vein image (75840) |
— |
$6,391 |
— |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
— |
$7,340 |
— |
| Ribs bilateral 3 views (71110) |
— |
$918 |
— |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
— |
$3,497 |
— |
| Rp loclzj tum plnr whole body single day imaging (78802) |
— |
$4,994 |
— |
| Rp loclzj tum spect 1 area single day imaging (78803) |
— |
$6,516 |
— |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
— |
$3,907 |
— |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
— |
$4,433 |
— |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
— |
$3,907 |
— |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
— |
$2,924.50 |
— |
| Rp therapy intra-arterial particulate admn (79445) |
— |
$2,717 |
— |
| Rp Therapy Intravenous Administration (79101) |
— |
$2,628 |
— |
| Sacroiliac Joints < 3 Views (72200) |
— |
$462 |
— |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
— |
$1,500 |
— |
| Scanogram (77073) |
— |
$719 |
— |
| Scapula complete (73010) |
— |
$737 |
— |
| Screening digital breast tomosynthesis (77063) |
— |
$475 |
— |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
— |
$1,037 |
— |
| Simulation intermediate (77285) |
— |
$2,195 |
— |
| Small bowel series (74250) |
— |
$1,591 |
— |
| Spec medical radj physics consltj (77370) |
— |
$1,835 |
— |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
— |
$2,428 |
— |
| Special dosimetry (77331) |
— |
$1,488 |
— |
| Special treatment procedure (77470) |
— |
$3,480 |
— |
| Spine thoracic 3 views (72072) |
— |
$949 |
— |
| Splenoportograpy rs&i (75810) |
— |
$5,984 |
— |
| Stereotactic body radiation delivery (77373) |
— |
$17,162 |
— |
| Superior sagittal sinus venogram (75870) |
— |
$3,191 |
— |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
— |
$721 |
— |
| Tbs Technical Calculation Only (77091) |
— |
$426 |
— |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
— |
$3,376 |
— |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
— |
$1,489 |
— |
| Ther rad simulaj-aided field setting complex (77290) |
— |
$3,944.50 |
— |
| Ther rad simulaj-aided field setting simple (77280) |
— |
$1,869 |
— |
| Thoracolumbar 2 views (72080) |
— |
$976 |
— |
| Thyroid carcinoma metastases img whole body (78018) |
— |
$3,432 |
— |
| Thyroid Imaging With Vascular Flow (78013) |
— |
$1,538 |
— |
| Thyroid uptake measurement (78012) |
— |
$1,527 |
— |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
— |
$3,365 |
— |
| Tmj unilateral (70328) |
— |
$516 |
— |
| Trabecular bone score (TBS), structural condition of the bone microarchitecture; technical preparation and transmission… (77090) |
— |
$426 |
— |
| Treatment device intermediate (77333) |
— |
$1,357 |
— |
| Treatment devices simple (77332) |
— |
$1,166.50 |
— |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
— |
$5,767 |
— |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
— |
$3,428 |
— |
| Tx devices design & construction complex (77334) |
— |
$2,463.50 |
— |
| Ultrasound elastography first target lesion (76982) |
— |
$1,228 |
— |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
— |
$1,228 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$624 |
— |
| Umbilical-artery Doppler (OB) (76820) |
— |
$713 |
— |
| Unlisted fluoroscopic procedure (76496) |
— |
$607.50 |
— |
| Unlisted Procedure Clinical Brachytherapy (77799) |
— |
$7,002 |
— |
| Unlisted Ultrasound Procedure (76999) |
— |
$831 |
— |
| Upper Extremity Infant (73092) |
— |
$438 |
— |
| Urethrocystography retrograde rs&i (74450) |
— |
$1,162 |
— |
| Urethrocystography voiding (74455) |
— |
$1,469 |
— |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
— |
$1,573 |
— |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
— |
$1,741 |
— |
| Us abdl aorta screen aaa (76706) |
— |
$890 |
— |
| Us breast unilateral complete (76641) |
— |
$1,228 |
— |
| Us breast unilateral limited (76642) |
— |
$1,005 |
— |
| Us chest (76604) |
— |
$973.50 |
— |
| Us compl joint r-t w/image documentation (76881) |
— |
$1,688 |
— |
| Us elastography parenchyma (76981) |
— |
$1,228 |
— |
| Us guided compression repair (76936) |
— |
$1,738 |
— |
| Us kidney transplant (76776) |
— |
$1,589 |
— |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
— |
$2,111 |
— |
| Us ob transvaginal (76817) |
— |
$1,047.50 |
— |
| Us pelvic non ob complete (76856) |
— |
$865 |
— |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
— |
$1,310 |
— |
| Us pregnancy ltd (76815) |
— |
$935 |
— |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
— |
$1,544 |
— |
| Us retroperitoneal complete (76770) |
— |
$1,648.50 |
— |
| Us retroperitoneal limited (76775) |
— |
$757 |
— |
| Us scrotum and contents (76870) |
— |
$1,300.50 |
— |
| Us soft tissue head/neck (76536) |
— |
$1,318 |
— |
| Us transrectal (76872) |
— |
$1,553 |
— |
| Us transrectal prostate volume (76873) |
— |
$1,299 |
— |
| Us xtr non-vasc lmtd (76882) |
— |
$1,232 |
— |
| Us, eye b-scan (76512) |
— |
$712 |
— |
| Venogram extremity bilateral (75822) |
— |
$3,301 |
— |
| Venogram orbital (75880) |
— |
$2,224 |
— |
| Venography caval inferior serialography rs&i (75825) |
— |
$4,824 |
— |
| Venography caval superior serialography rs&i (75827) |
— |
$4,902 |
— |
| Venography extremity unilateral rs&i (75820) |
— |
$2,661 |
— |
| Venography Renal Bilateral (75833) |
— |
$5,738 |
— |
| Venography renal unilateral selective rs&i (75831) |
— |
$5,433 |
— |
| Venography venous sinus/jugular cath rs&i (75860) |
— |
$3,608 |
— |
| Venous sampling thru cath w/wo angiography rs& (75893) |
— |
$5,148 |
— |
| Vertebral fracture assessment via dxa (77086) |
— |
$489 |
— |
| Wrist 2 views (73100) |
— |
$586 |
— |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
— |
$1,152 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$680 |
— |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
— |
$720 |
— |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
— |
$2,023 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$641 |
— |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
— |
$724 |
— |
| X-ray exam entire spi 4/5 vw (72083) |
— |
$656 |
— |
| X-ray exam hip uni 1 view (73501) |
— |
$530 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$508 |
— |
| X-ray exam hip uni 4/> views (73503) |
— |
$1,034 |
— |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
— |
$1,459 |
— |
| X-Ray Exam Hips Bi 5/> Views (73523) |
— |
$1,459 |
— |
| X-ray exam of femur 1 (73551) |
— |
$489 |
— |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
— |
$765 |
— |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
— |
$491 |
— |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
— |
$793 |
— |
| X-ray head for orthodontia (70350) |
— |
$385 |
— |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
— |
$590 |
— |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
— |
$654 |
— |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
— |
$811 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$720 |
— |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
— |
$168 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$930 |
— |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
— |
$1,318 |
— |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
— |
$1,060 |
— |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
— |
$760 |
— |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
— |
$786 |
— |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
— |
$861 |
— |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
— |
$1,728 |
— |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
— |
$742 |
— |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
— |
$897 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$759 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$732 |
— |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
— |
$783 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$996 |
— |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
— |
$560 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$1,132 |
— |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
— |
$857 |
— |
| X-Ray Spine One View - Xr Spine (72020) |
— |
$569 |
— |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
— |
$739 |
— |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
— |
$739 |
— |
| X-Ray Teeth Single - Xr Teeth 1 View (70300) |
— |
$222 |
— |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
— |
$881 |
— |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
— |
$767 |
— |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
— |
$499 |
— |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
— |
$723 |
— |
| Xr c-spine 6 or more views (72052) |
— |
$1,194 |
— |
| Xr chest 4+ views (71048) |
— |
$698 |
— |
| Xr finger(s) 2+ views (73140) |
— |
$532 |
— |
| Xr internal auditory meati complete (70134) |
— |
$641 |
— |
| XR Mastoids < 3 Views Bilateral (70120) |
— |
$433 |
— |
| Xr shoulder 1 view (73020) |
— |
$642 |
— |
| Xr spine cervical 4 or 5 views (72050) |
— |
$1,031 |
— |
| Xr tibia/fibula 2 views (73590) |
— |
$730 |
— |
| Xr tmj bilateral (70330) |
— |
$620.50 |
— |
| Xray knee 1 or 2 views rt (73560) |
— |
$680 |
— |